Employment Disputes Insurance Enquiry Form

Name *

Job title

Organisation

Organisation Address

Sector/Industry *

Phone number *

Email Address *

Total number of workers (including all full and part time employees, partners and directors) *

IMPORTANT NOTE: If you answer “Yes” to any of the following questions please provide additional detail.

Has the business previously held any form of Employment Disputes Insurance? *

Has any Insurer ever declined your business, refused renewal, cancelled a policy or imposed special terms when you have applied for Employment Disputes Insurance? *

In the past three years has there been a need for your business to initiate or defend any actions in respect of an employment dispute? *

Has your business, within the last six months, dismissed any staff, made staff redundant or are there any circumstances which may result in dismissal or redundancy of staff within the next 6 months? *

Is any worker currently off work through an illness or disability that has lasted for more than 30 consecutive days? *

Is the Business aware of any existing circumstances which may or could lead to an employment dispute claim under the insurance cover? *

In the last three years have you been taken over, merged with, acquired or disposed of any companies or significant business activities, or are any currently under consideration? *

Are there any other material facts to be disclosed to Insurers regarding this Proposal for Insurance? *

If the response to the next 2 questions is "No" then please confirm whether it is intended to implement written particulars and/or procedures and when this is planned to take place

Does your business have written disciplinary rules and procedures which apply to all workers? *

Does your business provide written particulars for all workers by means of contracts of employment and staff handbooks explaining matters relating to their employment? *

Additional information *

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